On: What happens when you cough, sneeze,or laugh……

My day at work as a physical therapist is spent treating patients with running and pelvic disorders. Perhaps the most interesting part is spent educating patients about and providing treatment for disorders of bladders, tailbones, and pelvic floors- primarily in women, but I see some men with these issues as well, particularly after prostatectomy and certain forms of cancer. This involves a variety of different diagnosis, and I see men and women of all ages and backgrounds. Primarily folks are seeking treatment when they become incontinent.  This means that several times each day I sit down with a patient who begins by saying “when I laugh, sneeze, or exercise I wet my pants” or “I feel like I have to go to the bathroom all the time”… and suffice it to say they are embarrassed. This is more common than initially thought in female runners, and high-impact athletes such as basketball players. Today this post will focus on females who are battling incontinence.

Ladies! You need not be embarrassed! I see elite athletes, new moms, grandmothers, and everyone else in between with this circumstance, it is happening more than people think, and it is curable! Depending on the extent of symptoms and your medical history, a physical therapist in your area specializing in women’s health can be of great help.

Incontinence occurs most commonly due to weakness in the pelvic floor muscles, which act as a sling, enveloping and supporting components of the bladder, colon, and uterus within the pelvis. These muscles attach to the coccyx and the pubic rami (front and back of the pelvis) via tendons.  Pelvic floor weakness is often attributed to pregnancy and delivery of a baby, however underlying pelvic floor weakness can occur in the absence of bearing a child.  Weakness is then worsened with the pounding of running or other impact sports (or simply coughing, sneezing, and laughing) leading to leaking.

 

In the case of pelvic floor muscle weakness, incontinence is treated with a very specific and individualized regiment of pelvic floor muscle exercises. Kegel’s are the name of the exercise, named after Dr. Kegel in the 1950’s. Kegel is not the name of the muscle themselves. A contraction of the pelvic floor muscles is one in which the pelvic floor muscles squeeze and lift upward. This is the mechanism that you would use to shut off the flow of urine if you were going to the bathroom and your cell phone rang and you absolutely had to take the call. Believe it or not, there is a right and a wrong way to do a  Kegel contraction. The lifting component is the most important to be aware of. Many women are pushing down, which makes the situation even worse. A pelvic floor physical therapist will determine the proper regiment for you and create an individualized program. “Kegels” can get a bad reputation, and this exercise is certainly not for everyone, particularly if you have pelvic pain, which is why it is important to seek care from a qualified health care professional.

During pregnancy or with certain types of injuries, the tendons to these muscles can become stretched. In order to determine the extent of stretching and tearing, internal pelvic examination is done by a gynecologist and or highly trained physical therapist. Other forms of treatment might be necessary if this is the case, but many people will respond in some form to a specified Kegel program.

As mentioned before, contrary to popular belief, Kegels are not for everyone. Though studies show that they are a first line of treatment for incontinence when paired with bladder behavior training (also done with the help of a pelvic floor physical therapist), they are not a good treatment for individuals with certain forms of pelvic or coccyx (tailbone) pain. If you are experiencing pelvic or coccyx pain in addition to incontinence, the pain will need to be managed first, as the Kegels can tighten already distressed muscles and make the pain worse.

So there you have it. If you are experiencing these symptoms there are pelvic floor physical therapists in your area that are happy to help.

Visit the American Physical Therapy Association’s webpage PT finder to find a trained provider in your area:

http://www.apta.org/apta/findapt/index.aspx?navID=10737422525

Make your day great, and don’t let leaking get in your way of a good time!

Amanda

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About runningyourbody

I am a Doctor of Physical Therapy (DPT), Certified Pilates instructor, and runner with celiac disease. I am passionate about educating people on running, pilates, and women’s health topics. I am trained in the treatment of pelvic floor dysfunction, as well as pre and post partum impairments. In my free time I can be found anywhere outside. I enjoy training for races with friends, cooking gluten free meals, and traveling with my husband. My goal is to share information with you in a lighthearted and enjoyable forum. I am always contributing fun and interesting posts on my blog. Feel free to check it out @ https://runningyourbody.wordpress.com/
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2 Responses to On: What happens when you cough, sneeze,or laugh……

  1. I was unaware that kegel’s were contraindicated with coccyx pain. Something to watch out for when I begin working on my own as a pilates instructor. Thank you for the informative article 🙂

    • Yes in the presence of coccyx pain most of the time there are trigger points present in the pelvic floor that need to be managed by a physical therapist. They may or may not be able to return to kegels depending on the extent of their diagnosis. Thank you for reading!

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